Chicago tackles social determinants with four-year vision for healthier city

Social determinants of health are at the center of an ambitious new plan to improve health in one of the nation’s most historic and populous cities: Chicago.

In March, Chicago Mayor Rahm Emanuel and officials with the Chicago Department of Public Health released Healthy Chicago 2.0, a four-year plan. Developed with input from more than 130 organizations across diverse sectors, the plan places an emphasis on achieving health equity.

During the planning process, public health stakeholders, including city residents, identified 10 priority areas on which to take action, including increasing access to health care, improving education, reducing violence and improving social and economic conditions. Overall, the final Healthy Chicago 2.0 outlines 30 goals, 82 objectives and more than 200 strategies across 10 action areas.

Julie Morita, MD, Chicago’s health commissioner, said that in reviewing the wealth of data that led to Healthy Chicago 2.0, it became clear that while the city had made great progress on health indicators — from teen birth rates to smoking — persistent disparities remained that required a concerted focus on the social and economic roots underpinning poor health.

“It’s really important for us to make the connections between these determinants and poor health outcomes so we can engage the right partners,” Morita told The Nation’s Health. “It’s challenging for us, because we don’t have dedicated resources to do all that — housing, education, transportation are not primarily our responsibility. So it’s up to us to rally together our partners and make sure we’re looking at things from a health perspective.”

Among the main indicators that will be used in measuring Healthy Chicago 2.0 progress are economic hardship and child opportunity. According to Healthy Chicago 2.0, more than 835,000 Chicago residents were living in economic hardship as of 2014, with the hardship measurement based on determinants such as crowded housing, poverty, unemployment and education level.

Not surprisingly, a community with a high hardship score typically has worse social and economic conditions than communities with lower hardship scores. Using a measurement known as the Child Opportunity Index, the report also found that 48 percent of Chicago children were living in “low child-opportunity areas,” with 1 in 2 black and Hispanic children living in such areas, compared to 1 in 50 white children.

The index includes more than a dozen social, economic and environmental indicators, including proximity to high-quality early childhood education, proximity to toxic waste sites, and poverty and unemployment rates. Healthy Chicago 2.0 aims to reduce both economic hardship and the number of children living in low or very low child-opportunity areas by 5 percent each by 2020.

Healthy Chicago 2.0 features an entire chapter dedicated to addressing the root causes of health. For example, the plan aims to improve built environments in support of healthy living, with strategies such as institutionalizing the city’s complete streets policy as well as fostering partnerships between bike-sharing businesses and public health officials to pinpoint areas of need and inequity.

In regard to the economic factors, Healthy Chicago 2.0 recommends expanding the state’s earned income tax credit as well as supporting community-level business incubators and small business development, among other strategies.

However, Morita emphasized that there is no single overarching solution when it comes to addressing social determinants, which is why a diverse group of public and private partners are essential to driving healthy change.

To support that endeavor, Healthy Chicago 2.0 promised to formalize a health-in-all-policies approach within city government. In May, the Chicago City Council did just that, passing a resolution to integrate the approach into future development and establishing a Health In All Policies Task Force with representatives from every city department.

“Addressing the social determinants isn’t something that happens overnight,” Morita said. “Is there a silver bullet? No. We have to look at all the root causes of poor health and address them comprehensively.”